Montañés Bermúdez R, Bover Sanjuán J, Oliver Samper A, Ballarín Castán J A, Gràcia García S
Servicios de Laboratorio, Fundació Puigvert, Universitat Autònoma de Barcelona FP/UAB, Red Nacional de Investigación en Nefrología (REDINREN), Instituto de Investigación Carlos III, Madrid, Spain.
Nefrologia. 2010;30(2):185-94. doi: 10.3265/Nefrologia.pre2009.Dic.5838. Epub 2009 Dec 14.
A recent report by the CKD-EPI Chronic Kidney Disease Epidemiology Collaboration) group describes a new equation to estimate the glomerular filtration rate (GFR). This equation has been developed from a population of 8,254 subjects who had the GFR measured by iothalamate clearance (mean 68 mL/min/1.73 m2, SD 40 mL/min/1.73 m2). It includes variables such as serum creatinine, age, sex and race with different formula according to race, sex and creatinine value. The CKD-EPI equation improved the accuracy and precision results of the current first-choice MDRD-IDMS (Modification of Diet in Renal Disease-Isotopic Dilution Mass Spectrometry) formula, specially for GFR > 60 mL/min/1.73 m2 in a group of 3,896 subjects.
The goal of our study was to compare the estimated GFR by using the new equation CKD-EPI with MDRD-IDMS in a wide cohort of 14,427 patients (5,234 women and 9,193 men), and to analyze the impact of the new CKD-EPI formula on the staging of patients with CKD.
Mean estimated GFR was 0.6 mL/min/1.73 m2 higher with CKD-EPI as compared to MDRD-IDMS for the whole group, 1.9 mL/min/1.73 m2 higher for women and 0.2 mL/min/1.73 m2 lower for men. The percentage of CKD staging concordancy between equations varied from 79.4 % for stage 3A and 98.6% for stage 5. For those patients younger than 70 years, 18.9 % and 24 % MDRD-IDMS stages 3B and 3A were reclassified as CKD 3A and 2 by CKD-EPI, respectively. For the same stages in the group younger than 70 years, the percentage of reclassified patients increased up to 34.4% and 33.4%, respectively.
The new CKD-EPI equation to estimate the GFR reclassifies an important number of patients to higher CKD stages (higher GFR), specially younger women, classified as CKD stage 3 by MDRD-IDMS.
慢性肾脏病流行病学合作组织（CKD-EPI）近期发布的一份报告描述了一种用于估算肾小球滤过率（GFR）的新方程。该方程是基于8254名通过碘他拉酸盐清除率测量GFR的受试者群体（平均68 mL/min/1.73 m²，标准差40 mL/min/1.73 m²）开发的。它纳入了血清肌酐、年龄、性别和种族等变量，并根据种族、性别和肌酐值采用不同的公式。CKD-EPI方程提高了当前首选的肾脏疾病饮食改良-同位素稀释质谱法（MDRD-IDMS）公式的准确性和精确性结果，特别是在一组3896名受试者中，对于GFR>60 mL/min/1.73 m²的情况。
我们研究的目的是在14427名患者（5234名女性和9193名男性）的广泛队列中，比较使用新的CKD-EPI方程和MDRD-IDMS估算的GFR，并分析新的CKD-EPI公式对慢性肾脏病患者分期的影响。
与MDRD-IDMS相比，CKD-EPI估算的全组平均GFR高0.6 mL/min/1.73 m²，女性高1.9 mL/min/1.73 m²，男性低0.2 mL/min/1.73 m²。方程之间慢性肾脏病分期的一致性百分比在3A期为79.4%，5期为98.6%。对于年龄小于70岁的患者，MDRD-IDMS的3B期和3A期分别有18.9%和24%被CKD-EPI重新分类为慢性肾脏病3A期和2期。在年龄小于70岁的组中，相同分期的重新分类患者百分比分别增至34.4%和33.4%。
用于估算GFR的新CKD-EPI方程将大量患者重新分类到更高的慢性肾脏病分期（更高的GFR），特别是被MDRD-IDMS分类为慢性肾脏病3期的年轻女性。
